Abstract
A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM–IV Criteria, Modified DSM–IV Criteria, Cavanaugh Criteria, and Endicott’s Criteria’s. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM–IV Criteria (23.3%), followed by the Endicott’s Criteria (13.8%), DSM–IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM–IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott’s criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients.
Highlights
In Malaysia, there are many patients with underlying terminal illness undergoing palliative care, which comprises of consultative palliative care services, inpatient palliative care units, outpatient clinics, and community palliative care and day care services [1]
Palliative care patients are often vulnerable to psychological distress that can range from mild feelings of sadness and vulnerability to significant depression and anxiety [2]
Cavanaugh Criteria, and Endicott’s Criteria) have not been carried out before in Malaysia, this study was carried out in two Malaysian centers, an urban and a semi-urban setting, to determine the prevalence of major depressive disorder based on the four sets of diagnostic criteria mentioned, and to determine the best diagnostic criteria to be used in palliative care patients in Malaysia. This is a multi-center cross-sectional study to determine the prevalence of major depressive disorder among palliative care patients based on the four sets of diagnostic criteria (DSM–IV Criteria, Modified DSM–IV Criteria, Cavanaugh Criteria, and Endicott’s Criteria)
Summary
In Malaysia, there are many patients with underlying terminal illness undergoing palliative care, which comprises of consultative palliative care services, inpatient palliative care units, outpatient clinics, and community palliative care and day care services [1]. Psychological distress affects patients in all aspects of life such as impairing their capacity to experience pleasure and meaning [3], to interact with their loved ones, and to arrange their practical and financial affairs [4]. Their ability to participate in treatment and cope with their illness is affected [2]. Major depressive disorder is a common mental health problem that causes significant mortality and morbidity It does affect a person’s emotional state and disrupts their functioning in both occupational and social aspects [5].
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